VISAGE INTEGRATIVE MEDICINE LLC NPI 1497345003

NPI Information

NPI: 1497345003
Provider Name: VISAGE INTEGRATIVE MEDICINE, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 45D2217629

Address:
3144 EXECUTIVE DR
SAN ANGELO, TX
ZIP 76904
Phone: (325) 617-4594
Get Directions

VISAGE INTEGRATIVE MEDICINE, LLC is a family nurse practitioner in San Angelo, TX. VISAGE INTEGRATIVE MEDICINE, LLC NPI is 1497345003. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3144 EXECUTIVE DR
SAN ANGELO, TX
ZIP 76904-802
Phone: (325) 617-4594
Fax: (324) 617-4593

The provider's authorized official is Susann Brundrett .
The authorized official title is Owner/provider and has the following contact phone number (325) 234-2181.

The CLIA number assigned to this NPI record is 45D2217629 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/19/2021 and was last updated on 1/19/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »